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Esophageal Cancer

When a person swallows, the muscular walls of the esophagus (which is located just behind the trachea [windpipe]), contracts to push food into the stomach. Glands in the lining of the esophagus produce mucus, which keeps the passageway moist and makes swallowing easier.

Cancer that begins in the esophagus is divided into two major types, squamous cell carcinoma and adenocarcinoma, depending on the type of cells that are malignant.

Squamous cell carcinoma occurs in the squamous cells lining the esophagus and usually occurs in the upper and middle part of the esophagus.

Adenocarcinoma occurs in glandular tissue, most often in the lower part of the esophagus near the stomach. An estimated nine out of 10 malignant stomach tumors are adenocarcinomas.

Early esophageal cancer usually does not produce symptoms. However, as the cancer grows, symptoms may include:

Difficult or painful swallowing

Severe weight loss

Pain in the throat or back, behind the breastbone or between the shoulder blades

Hoarseness or chronic cough

Vomiting

Coughing up blood

These symptoms may be caused by esophageal cancer or by other conditions. It is important to check with a doctor.

Risks

The exact causes of cancer of the esophagus are not known. However, studies show that any of the following factors can increase the risk of developing esophageal cancer. The risk is increased when two or more of the factors are present:

Age: Esophageal cancer is more likely to occur as people get older; most people who develop esophageal cancer are over age 60.

Sex: Cancer of the esophagus is more common in men than in women.

Tobacco Use: Smoking cigarettes or using smokeless tobacco is one of the major risk factors for esophageal cancer.

Alcohol Use: Chronic and/or heavy use of alcohol is another major risk factor for esophageal cancer. People who use both alcohol and tobacco have an especially high risk of esophageal cancer. Scientists believe that these substances increase each other's harmful effects.

Barrett's Esophagus: Tissues at the bottom of the esophagus can become irritated if stomach acid frequently backs up into the esophagus—a problem called gastric reflux. Over time, cells in the irritated part of the esophagus may change and begin to resemble the cells that line the stomach. This condition, known as Barrett's Esophagus, is a pre-malignant condition that may develop into adenocarcinoma of the esophagus.

Other Types of Irritation: Other causes of significant irritation or damage to the lining of the esophagus, such as swallowing lye or other caustic substances, can increase the risk of developing esophageal cancer.

Medical History: Patients who have had other head and neck cancers have an increased chance of developing a second cancer in the head and neck area, including esophageal cancer.

Prevention

A few lifestyle changes are suggested as a way to prevent or reduce the risk of developing esophageal cancer. The good news is that most of these esophageal cancer prevention tips will also help prevent many other types of cancer.

If you smoke, stop! This may be the single most important thing you can do to prevent esophageal cancer and improve your overall health. Smoking causes acid reflux and also damages cell DNA of the esophagus.

Limit alcohol consumption. Many esophageal squamous cell carcinomas and adenocarcinomas result from heavy alcohol consumption over a period of years. Abstaining from alcohol or drinking in moderation—no more than one drink daily for women or two drinks daily for men—can greatly reduce your risk of this type of esophageal cancer.

Eat a healthy diet. Eating healthy foods is a good way to reduce your risk factor for many diseases. Fresh fruits and vegetables, especially those that are dark green or yellow in color, are great for cancer prevention.

Keep a healthy weight. Being significantly overweight increases your risk of esophageal cancer as well as your risk of other serious health problems, such as diabetes, cardiovascular disease, and stroke. Talk to your family physician about developing a plan to lose weight by eating well and exercising regularly.

Diagnosis

Using a thin, lighted tube called an esophagoscope; your doctor can examine your esophagus and remove tissue to be examined later in the lab for potential signs of disease.

Treatment

As with any cancer, treatment for esophageal cancer depends on a number of factors, including the size, location, extent of the tumor, and the general health of the patient. At MedStar Health, an individualized plan of care is made for each patient, and may include surgery, chemotherapy, and/or radiation.

Patients are often treated by a team of specialists, which may include a gastroenterologist (a doctor who specializes in diagnosing and treating disorders of the digestive system), surgeon, medical oncologist (a doctor who specializes in treating cancer), and radiation oncologist (a doctor who specializes in using radiation to treat cancer).

Because cancer treatment may make the mouth sensitive and at risk for infection, doctors often advise patients with esophageal cancer to see a dentist for a dental exam and treatment before cancer treatment begins.

Esophagectomy is the surgical removal of the esophagus. Two types exist:

Transhiatal esophagectomy is performed on the neck and abdomen at the same time

Transthoracic esophagectomy involves opening the chest

In most cases, your doctor will use the stomach to create a new esophagus.

Your doctor will give you very specific instructions about how to prepare for this procedure. Please follow those directions exactly.

Benign Esophageal Disorders

The esophagus can develop many benign disorders, including:

Gastroesophageal reflux

Benign esophageal strictures that can cause swallowing problems

Benign tumors, such as leiomyoma

Esophageal cysts

Esophageal Diverticula

Esophageal spasm

Achalasia

These functional disorders can often be improved with surgery. However, it is critical that your surgeon understands the disease process and has experience in diagnosing and treating these conditions. MedStar Health thoracic surgeons are experienced in diagnosing and treating esophageal disorders using state-of-the-art surgical techniques.